Athletes are constantly plagued by injuries that can impair performance and hinder their ability to train. Nutrition and bioactive compounds can aid in tissue regeneration, delivering the appropriate building blocks for repair processes and attenuating oxidative stress and inflammation. Proper nutrition may even assist in mitigating injury by supporting recovery and tissue integrity. Low energy availability, micronutrient inadequacy, and poor hydration have all been linked with elevated injury incidence. Protein as well as vitamin C and zinc have been demonstrated to support healing and accelerate recovery in part due to their interaction with the immune system. The gut microbiome is also implicated in tissue regeneration as a key determinant of immune function. Finally, a variety of bioactive extracts from plants have been studied for their role in wound healing and tissue repair. Adopting a comprehensive approach to nutritional care is pivotal in sustaining athletic performance, promoting recovery, and alleviating injury risk.
Part 1: The gut microbiome and the implementation of pre-, pro-, and postbiotics
The gut microbiome determines how dietary components are metabolized and distributed. In addition, gut microbiota profoundly impact immunosurveillance, immune responsiveness, and inflammatory tone. Sports injury triggers a stress response that elicits a transient state of inflammation. Immune cells are rapidly recruited to the site of damage to begin tissue regeneration and reconstruction. The duration of each stage of the healing process is in part governed by nutrient status, metabolic health, and individual characteristics. The gut microbiome, through the metabolism of nutrients and secretion of signaling metabolites, can facilitate healing or perpetuate inflammation.
Dysbiosis induces chronic immunostimulation through the production of pro-inflammatory molecules, impaired gut barrier, and translocation of harmful substances such as bacterial endotoxins. Persistent inflammation leads to tissue catabolism via activation of NF-kB, MAPK, and TLR4, consequent production of TNF-a, IL-1b, and IL-6 cytokines, and repression of the anabolic PI3K/Akt/mTOR pathway. Catabolism incites release of myostatin, the expression of which triggers release of the muscle-specific E3 ubiquitin ligases, Muscle RING-finger protein-1 (MurF-1) and Muscle Atrophy F-box protein (Atrogin-1). These ligases concomitantly inhibit the IGF-1/PI3K/Akt pathway and drive Foxo1 transcription which acts to amplify protein breakdown.
Pre-, pro-, and postbiotics have been highlighted as therapeutic tools to maintain microbiome homeostasis, enabling the healing process to take place unobstructed. Both pre- and probiotics have been introduced in an effort to enhance production of short-chain fatty acid (SCFA) signaling metabolites. Prebiotics are digested by microorganisms in the GI tract, particularly Bifidobacteria and Lactobacilli, which generate SCFA as metabolic byproducts. Proliferation of SCFA-producing bacteria enhances GLP-1- and PYY-related insulin secretion while also suppressing NF-kB. Insulin secreted in response to nutrient intake and certain amino acids stimulates the anabolic PI3K/Akt/mTOR pathway that is central to protein synthesis and cell growth. Moreover, SCFAs target AMPK, PPAR-a, and PPAR-y pathways involved in energy metabolism. SCFAs additionally induce a shift in T cell balance toward an anti-inflammatory phenotype, activating regulatory T cells and T helper 17 cells to restore immune homeostasis, quell inflammation, and reduce tissue breakdown.
Thanks to their modulation of microbial communities and related metabolites, prebiotics have been presented as a way to mitigate gut barrier breakdown that occurs with heavy training. This can be especially beneficial in traumatic brain injury where the integrity of the GI lining becomes compromised, allowing for translocation of inflammatory bacterial components and metabolites. Such inflammatory molecules can disrupt the blood brain barrier and elicit a systemic immune response that potentiates brain injury. By regulating microbial distribution and metabolic function, as well as promoting an anti-inflammatory environment, prebiotics may act to protect the brain, suppress muscle protein degradation, and elevate muscle endurance.
Similarly to prebiotics, probiotics exhibit a profound ability to moderate bacterial species proliferation and distribution, thereby impacting metabolite production and immune status. Lactobacillus plantarum has been reported to lower the pro-inflammatory cytokines IL-1b and TNF-a, as well as MMP3 which participates in cartilage catabolism. Clostridium butyricum has been noted to diminish pro-inflammatory IL-17A and Th17 while promoting Treg response, thereby dampening the inflammatory process. Lactobacillus acidophilus, Bacillus coagulans, and Streptococcus thermophilus have additionally been observed to mitigate inflammation-induced muscle breakdown by repressing myostatin and inhibiting Atrogin-1 and MuRF-1. Akkermansia muciniphila may ameliorate revascularization implicated in the healing of bone tissue, as well as attenuate IL-6, Atrogin-1, and MuRF-1 involved in muscle breakdown. Certain bacterial strains such as Lactobacillus casei present in fermented milk have also been demonstrated to diminish the RANKL/OPG osteometabolic pathway that ordinarily intensifies bone resorption in response to inflammation or immobilization. In other studies, L. casei, L. paracasei, and Bifidobacterium animalis subsp. lactis A6 produced elevations in SCFA levels, thereby blunting muscle mass and strength loss.
Postbiotics contain inactivated bacteria or their active metabolites, including SCFAs, amino acids, peptidoglycans and others. Inactive bacteria may be better poised to pass through the mucus membrane to directly interact with epithelial cells as compared to live bacteria. Certain postbiotic strains, such as L. plantarum beLP1 found in kimchi, moderate MuRF-1 and Atrogin-1 and suppress p38 MAPK and ERK signaling which collectively serves to avert protein catabolism. A. mucinipihila HB05 has also demonstrated the capacity to upregulate follistatin and thereby counter the effects of myostatin. L. paracasei PS23 appears to shift inflammatory tone by prompting IL-10 expression while lowering CRP and IL-6. L. plantarum TWK10 and Lactobacillus paracasei have been observed to improve strength and muscle mass while attenuating markers of muscle damage.
While clinical studies are limited and more research is needed to refine optimal implementation strategies, the ability of pre-, pro-, and postbiotics to support sports performance and wound healing is biologically plausible. Many studies to date have demonstrated positive impacts with minimal side effects. These compounds have been noted to diminish oxidative stress, repress inflammatory cascades, and improve immune system function. They additionally enhance SCFA production and promote a eubiotic state of microbial communities. Collectively, when used appropriately these compounds may serve as an adjunct to nutrition to bolster athletic performance and recovery.
Şahin-Demirci K, Dal N, Gönen-Çolak B, Akman O, Raposa B, Ağagündüz D. The role of biotics and bioactive compounds in sports injuries: a narrative review. Front Nutr. 2026;13:1813030. Published 2026 May 14. doi:10.3389/fnut.2026.1813030